title: Long-term patient satisfaction with michigan four-wall sacrospinous ligament suspension for prolapse.
abstract: OBJECTIVE
  To describe patient satisfaction after Michigan four-wall sacrospinous ligament suspension for prolapse and identify factors associated with satisfaction.
  
  
  METHODS
  Four hundred fifty-three patients were asked to rate their satisfaction with surgery and complete validated quality-of-life instruments. Postoperative support was extracted from the medical record and assessed when possible. Factors independently associated with patients who were "highly satisfied" were identified with multivariable logistic regression.
  
  
  RESULTS
  Sixty-two percent (242/392) reported how satisfied they were 8.0±1.7 years later. Fifty-seven percent had failed prior prolapse surgery, and 56% had a preoperative prolapse 4 cm or greater beyond the hymen. Ninety percent were satisfied; 76% were "completely" or "very" satisfied and they were considered "highly satisfied" for analysis. Fourteen percent reporting being "moderately" satisfied and they were considered among those "less satisfied." Women with lower scores on the postoperative Pelvic Floor Distress Inventory-20 were more likely to be "highly satisfied." Postoperative anatomic data were available for 67% (162/242) and vaginal support was observed at or above the hymen in 86%. Women with preoperative Baden Walker grade 3 or 4 prolapse were more likely than those with grade 2 prolapse to be "highly satisfied." Women with advanced postoperative prolapse (grade 3 or 4) were less likely and those with grade 2 support were as likely to be "highly satisfied" as those with grade 0 or 1 support.
  
  
  CONCLUSIONS
  The Michigan four-wall sacrospinous ligament suspension is an anatomically effective approach to vault suspension with a high rate of long-term patient satisfaction. Postoperative vaginal support at the hymen does not negatively affect patient satisfaction.
  
  
  METHODS
  III.
authors.affiliation: Pelvic Floor Research Group and the Division of Gynecology, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Kindra A
authors.initials: KA
authors.lastname: Larson
authors.forename: Tovia
authors.initials: T
authors.lastname: Smith
authors.forename: Mitchell B
authors.initials: MB
authors.lastname: Berger
authors.forename: Melinda
authors.initials: M
authors.lastname: Abernethy
authors.forename: Susan
authors.initials: S
authors.lastname: Mead
authors.forename: Dee E
authors.initials: DE
authors.lastname: Fenner
authors.forename: John O L
authors.initials: JOL
authors.lastname: DeLancey
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Morgan
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008499:Medical Records; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery